By Teresa Williams, MSW, LCSW, CEO, HomeCare Connect
Of all the psychosocial factors affecting workers’ compensation claims, family dynamics play a significant role in catastrophic claims requiring home health care. The more severe the injury, the bigger the impact on the family.
A life-altering injury will stress any family. A person who could work, drive and take care of themselves one day can be incapacitated the next. Injured workers suffering from traumatic brain injuries often undergo major behavioral changes including memory loss, mood swings, anger, poor judgment, and issues with impulse control.
Life as the family knew it totally changes, especially when the injured worker is unable to handle activities of daily living, like cooking, eating and bathing. A spouse may have to quit a job in order to provide 24/7 care. If the injured worker is young and single, the mom may become the caretaker once again.
When the injury is so severe that the injured worker cannot speak for himself, a family member needs to represent him. This is particularly challenging when the injured worker has been the primary wage earner and decision maker and his wife needs to make decisions on his behalf. Not only do they face incredible financial pressures, but they have to deal with role reversals as well.
Household income usually drops significantly. The Occupational Health & Safety Administration (OSHA) estimates that employers only provide about 20 percent of the total financial cost of workplace injuries and illnesses through workers’ compensation and says that costs are borne mainly by injured workers, their families and taxpayer-supported social services. Workplace injuries are particularly devastating to low-income families who were already living paycheck to paycheck. Relatives may need to take second and third jobs, and the family may need to go on food stamps or seek other governmental assistance programs.
In many ways, a catastrophic injury can feel like the death of a family member; the person the family once knew and loved is never going to be the same. Neither is the life the family once led. Families may actually experience the various stages of grief: denial, anger, bargaining, and depression before moving into acceptance.
For optimal recovery, the injured worker needs a calm, stable home environment with attentive and caring loved ones. Dysfunctional families tend to live in turmoil and uncertainty, and their compliance with treatment can be erratic. Some fail to give medications as prescribed or block access to care givers and others may take out their frustration on the injured worker.
It’s important to determine what type of family surrounds the seriously injured worker early in the claim and take steps to reduce any negative influences. One way to do this is to conduct a biopsychosocial assessment that examines the strength and resilience of the family and its financial and fund management abilities, along with the injured worker’s physical, psychological and social levels of functioning. The evaluation should carefully consider preexisting mental health and physical issues and determine any risk that the injured worker will harm himself or others. A thorough biopsychosocial assessment provides insight into how well the injured worker will be able to function in the home environment and recommends the types of services, education and other resources the injured person and the family need.
Another indicator of how well the family can support the injured worker is its coping style. Healthy families make appropriate decisions, deal with issues as they come up, and recognize that they cannot manage everything on their own. They ask for help and surround themselves with a support system of extended family members and friends, therapists and social workers. Dysfunctional families tend to be argumentative and find fault with the treatment plan or team.
Because coping behaviors usually become apparent soon after the injury occurs, the treatment team at the hospital or rehabilitation center can share observations and make recommendations for specific interventions that can help the family and injured worker better cope with the circumstances they are facing.
One thing that all families need is education about the status of the injured worker’s recovery, treatment plan, and home health needs prior to discharge from the hospital or rehabilitation center. It’s especially important to set realistic expectations for any future progress. Relatives, even highly educated, medical professionals have been known to have problems accepting the recovery limitations of their loved ones.
A social worker or field case manager should be assigned to work with the injured worker and family during the transition into the home. This is particularly important if the family is dysfunctional and the atmosphere is tense. While workers’ compensation plans do not usually cover psychological services for family members, a social worker can recommend community mental health providers, support groups, and religious counselors who can help the relatives acquire good coping skills.
A critical service that workers’ compensation insurance companies recognize and provide is respite care for family members. Caregiving, especially 24/7 care, takes a huge toll on a spouse or other family member. Approximately half of the caregivers in a study of primary caregivers of adult outpatients with a traumatic brain injury reported elevated levels of stress, with spouses mentioning depression more often than parents. These caregivers also showed greater levels of unhealthy functioning in these types of difficult situations.
Some spouses become so overwhelmed that they leave the home environment because they cannot adjust to the “new normal.” Then the injured worker needs to receive 24/7 home health services or move to a skilled nursing center. Providing respite care once or twice a month allows the primary caregiver to get out, decompress, do things for themselves, and re-charge. Preventing caregiver burnout can save families and money to the bottom line of the claim.
If members of the family suffer from a mental illness, the company managing home health services for the injured worker needs to work closely with the home healthcare providers and keep the claims manager informed and ready to intervene if a situation deteriorates. There are times that the family member is not the best person to oversee the care. In one such case, a young male worker suffered from a brain injury that caused extreme impulse control issues. He would suddenly leave the house and run down the middle of the street. His sister refused to have him committed to a mental health facility despite the danger he clearly posed to himself. The treatment team had to intervene to have him hospitalized and eventually arranged to have an independent guardian manage his care.
Managing family dynamics takes a coordinated team effort and excellent communication. The team, which may include the adjuster, the clinical care coordinator overseeing home health services, field case manager, home healthcare providers, social workers, and treating physician, needs to monitor issues and intervene to maintain stability. Interventions can take the form of financial assistance, a food bank, education, respite care, support groups, psychiatric care or counseling.
Catastrophic injuries place extra demands on families, including those that were not that strong in the first place. Giving families the tools they need to help them make good decisions, cope well with changes, and reduce their stress goes a long way to facilitating a safe and positive environment of recovery.
About Teresa Williams
Teresa Williams, MSW, LCSW is the CEO of HomeCareConnect, which manages the quality and cost of home healthcare, durable medical equipment and home modifications in workers’ compensation Before co-founding Home Care Connect in 2011, she was a partner in a Medicare Set-Asides company. A Licensed Clinical Social Worker, Teresa previously worked in psychiatric settings in hospitals, both in management and therapeutic roles. She can be reached at TWilliams@homecareconnect.com.
About HomeCare Connect
Specializing in catastrophic cases, HomeCare Connect focuses exclusively on managing the quality and cost of home health, durable medical equipment and supplies and home modifications for workers’ compensation payers. With more than 17,000 contracted network providers, its services include nursing, home infusion, respiratory therapy, speech and occupational therapy, prosthetics and orthotics, and the coordination of DME and supplies along with managing home modifications. HomeCare Connect’s partners consolidated their 20-plus years of workers’ compensation experience into offerings and service standards that ensure that injured workers receive excellent care in the fastest time frames at the most affordable prices. HomeCare Connect guarantees response to referrals within two hours and the delivery of an initial medical summary within two days. Listed among the fastest growing, privately held companies in the Orlando, Florida region, HomeCare Connect serves clients nationally and can be reached at www.homecareconnect.com or 855-223-2228.
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